WHO Board adopts decision on trade and health

Martin Khor and Sangeeta Shashikant

The WHO Executive Board has adopted a decision to recommend that the next World Health Assembly adopt a resolution on international trade and health which urges member states and the WHO secretariat to take action to make national trade and health policies more coherent, especially in light of the health implications of international trade agreements.

The resolution gives a broad mandate to the WHO secretariat to assist countries to frame coherent trade and health policies and to understand the implications and challenges that trade agreements may have for health. The WHO is also asked to support policy coherence between trade and health at regional and global levels.
The decision was taken on the evening of Wednesday (25 January 2006), without discussion. It is understood that the final document (EB117.R5) had already been negotiated by some member states prior to its being introduced and adopted on Wednesday.
A draft of the resolution had been first proposed by a group of 14 countries, coordinated by Thailand, at the last Executive Board meeting on 26-27 May last year. The other countries were Benin, Bhutan, Bolivia, Brazil, Canada, China, Iraq, Jamaica, Kenya, Nepal, Sudan, Tonga and Vietnam.
The move reflected growing concerns of the developing countries over the adverse effects of bilateral and regional free trade agreements on health policies.
In particular, many national health authorities are increasingly worried that intellectual property provisions in FTAs that have been concluded or that are being negotiated would affect access to medicines, as they extend patent protection for medicines, restrict the grounds for compulsory licenses and establish "data exclusivity" (protection of clinical trial data), all of which make it difficult for generic medicines to be supplied.
Some countries have also been concerned about the implications of the opening up of health services under the WTO services agreement as well as bilateral FTAs.
A lengthy and sometimes heated debate had taken place at last May's Board meeting, with proposals made by some developed countries to water down the original proposal of the developing countries. The Board decided on 27 May to defer the decision to its next meeting.
The WHO Secretariat prepared a report (EB117/10 dated 1 December 2005) containing the original resolution, together with alternative language in some parts reflecting some of the amendments proposed at the May 2005 meeting.
At Wednesday's meeting, a new draft dated 25 January was adopted. It contains basically the same resolution as the original draft submitted by Thailand.
In the adopted decision, the Executive Board recommended to the 59th World Health Assembly to adopt the resolution. In the resolution, the WHA recognizes the demand for information about the possible implications of international trade and trade agreements for health and health policy at national, regional and global levels.
It is also "mindful of the need for all relevant ministries, including those of health, trade, commerce, finance and foreign affairs, to work together constructively in order to ensure that the interests of trade and health are appropriately balanced and coordinated."
Member States are urged:
(1) to promote dialogue at national level to consider the interplay between international trade and health;
(2) to adopt, where necessary, policies, laws and regulations that address issues identified in that dialogue and take advantage of the potential opportunities, and address the potential challenges, that trade and trade agreements may have for health;
(3) to apply, or establish, where necessary, coordination mechanisms involving ministries of finance, health, and trade, and other relevant institutions, to address public health related aspects of international trade;
(4) to create constructive and interactive relationships across the public and private sectors for the purpose of generating coherence in their trade and health policies;
(5) to continue to develop capacity at national level to track and analyse the potential opportunities and challenges of trade and trade agreements for health-sector performance and health outcomes.
In the resolution, the WHA also requests the WHO Director-General:
(1) to provide support to Member States, at their request and in collaboration with the competent international organizations, in their efforts to frame coherent policies to address the relationship between trade and health;
(2) to respond to Member States' requests for support of their efforts to build the capacity to understand the implications of international trade and trade agreements for health and to address relevant issues through policies and legislation that take advantage of the potential opportunities, and address the potential challenges, that trade and trade agreements may have for health;
(3) to continue collaborating with the competent international organizations in order to support policy coherence between trade and health sectors at regional and global levels, including generating and sharing evidence on the relationship between trade and health;
(4) to report through the Executive Board to the Sixty-first World Health Assembly on progress made in implementing this resolution.
The resolution will be on the agenda of the World Health Assembly which meets in May. Amendments can still be made to it following discussion of the issue.
A WHO secretariat report on international trade and health, introduced at the May 2005 Board meeting, had discussed the implications of trade and trade agreements on health. It mentioned four WTO agreements that may affect public health that are of particular importance to WHO's work: the General Agreement on Trade in Services (GATS), and the agreements on Application of Sanitary and Phytosanitary Measures (SPS), on Technical Barriers to Trade (TBT), and on
Trade-Related Aspects of Intellectual Property Rights (TRIPS).
Increasing trade in health services challenges the capability of ministries of health to assess accurately and respond rapidly to the risks and opportunities for population health, said the report. There may also be the potential of increasing openness in the health sector under GATS, in its four "modes of supply".
Countries also face challenges in ensuring compliance with the disciplines of SPS and TBT. This is particularly the case in the areas of food safety, diagnostic devices and medicines quality, safety and efficacy, respectively, in which the trade agreement creates obligations.
The WHO report said that ministries of health "need the capability, in terms of expertise and access, to provide their colleagues in the trade and finance ministries with the best evidence on the potential impact of trade and trade agreements on health outcomes, so that ongoing multilateral, regional, or bilateral trade negotiations may be properly informed."
Another highlight of this week's Board meeting was a plea by the Brazilian delegation for the WHO and the Executive Board to build solidarity on the need to achieve universal access to medicines, and to address the problem of intellectual property in this regard.
Brazil made this call during the discussion on HIV/AIDS on Tuesday (24 January). It said the "3 by 5 initiative" had failed to achieve its target, and it was important to analyse why.
Before the Board was the WHO report on "HIV/AIDS Universal access to prevention, care and treatment" (EB 1117/6), which stated that there were almost 5 million new infections and more than three million deaths from the disease in 2005.
The report recalled the WHO-UNAIDS "3 by 5" initiative aimed at expanding access to antiretroviral treatment in low and middle income countries to 3 million AIDS patients by the end of 2005. Between June 2004 and June 2005 the number of people receiving treatment rose from 440 000 to about one million, and the report said the target has been "catalytic at the global level".
However, during the discussion, Brazil said the targets of the "3 by 5 initiative" had not been achieved. It was important to recognise this failure instead of painting a rosy picture of the situation.
It was necessary to have an in-depth analysis of why the "3 by 5 initiative" target was not achieved, said Brazil. Either the initiative was overly ambitious, or there was a lack of availability of drugs or finances, or human resource problems.
If the lessons of failure of the "3 by 5 initiative" are not learned, then there will be failure in providing "universal access", said Brazil.
It added that the Brazilian Ministry of Health spent annually $400 million for ARV drugs, with 67% of the sum spent on only 3 drugs and it is difficult to get major pharmaceutical companies to reduce prices.
Brazil said the WHO and its Members had a choice of either being in favour of companies or the people. This is an organization that has to resolve the problems of people, and thus a strong position has to be taken on intellectual property rights.
It added that AIDS can be contained, but for that to happen a firm political decision was needed and there had to be a hard look at intellectual property and its implication on prices.
Brazil said it could have produced the drugs needed at lower cost, but there were problems posed by intellectual property. It also referred to the situation in Africa where the per capita income is $200-300 per year, but the costs of treatment is very expensive.
It suggested that the Executive Board has a role to play and that there needs to be solidarity on this issue. As part of the solution, the problem of intellectual property had to be addressed, and a political decision has to be taken to give priority to research into the health problems of the poor.

Martin Khor and Sangeeta Shashikant
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